Abstract

Background: Pleuroscopy is a minimal invasive procedure with increasing popularity among pulmonologist

Objective: A prospective study to assess the efficacy and safety for pleuroscopy in diagnosis of pleural effusion and talc poudrage for malignant pleural effusion.

Methods: From July 2009-June 2013, all patients undergo pleuroscopy for diagnostic or therapeutic indications were included and followed up for 6 months. Clinical data including diagnostic yield, complication and outcome were recorded prospectively.

Result: 81 patients were recruited. Overall diagnostic yield was 90% [89.5%(34/38) for malignant disease, 91.7%(11/12) for benign disease and 85.7% (6/7)for TB pleuritis]. Minor complications including talc related fever (0.14%), prolonged air leak (0.04%), increase oxygen consumption (0.01%) and CO2 retention (0.01%) were observed. No mortality or major complication occurred. Minimal sedation was given: average dose of pethidine, fentanyl and dormicum were 48.8mg(SD6.57), 13.1mcg(SD19.06) and 0.45mg(SD0.79) respectively. Duration of chest drain and length of stay were 1.98 days(SD1.42) and 5.1 days(SD2.8) respectively. Total 51 talc poudrage were done with average dose of talc was 4.47g(SD0.97). 19 patients had talc poudrage base on macroscopic appearance of pleura before histological diagnosis. Success rates with pleuroscopic talc pleurodesis for malignant pleural effusions were 86.7%, 72.5% and 64.7% at 1, 3 and 6 months respectively. 15 patients died within the follow up period.

Conclusion: Pleuroscopy is a safe procedure with high diagnostic yield for undiagnosed pleural effusion and efficacious procedure for talc poudrage in malignant pleural effusion.